24 Oct Primary Care Networks – a threat to ‘at scale’ GP groups, or an opportunity?
Primary Care Networks (PCN’s) have existed in various forms for some time, but detailed guidance (currently in draft form) is expected in the coming weeks. All practices will be included within a PCN, although the degree of practice integration within the networks will be locally determined. The potential impact on individual practices has been discussed, but what about the effect on large GP groups? Does PCN membership reduce, or even take away, the necessity to merge practices, or join an existing large GP provider, in order to get the benefits of working at scale?
The network population will be circa 50,000, so they will typically include between 6 and 12 practices that will work closely together. At a minimum, they will all work with the same community, mental health and acute teams, utilising common processes and procedures. As the network develops, some will explore common or joint approaches to workforce, digital, clinical governance and estates solutions. The guidance may signpost the development of a common business model, such as joint contracting with commissioners utilising a lead provider approach or a joint venture vehicle.
The stated benefits of working at scale include operational efficiencies, reduced duplication of effort through the use of standardised processes, and working together to strengthen the workforce and deploy technology. Additionally, larger groups may be better able to influence their local health systems by, for instance, sending representatives to take part in STP processes. In theory, practices could gain all these benefits by working closely together in a PCN, and this might be perceived as an attractive option, particularly if funding is provided to support PCN development?
What are the implications for existing large GP groups, who will also find themselves part of the new Networks? Where can they provide ‘added value’ to practices, and how might they work with non-member practices in the same network?
There may be opportunities for large groups to take responsibility for running the networks, shaping their development and influencing how new working patterns with primary care and other colleagues are developed. Close working with non-member practices could allow even greater economies of scale to be generated, and the complete population coverage that this would produce may generate additional options to implement network-wide services, for example out of hours provision or video consultation
It is expected that PCNs will develop at different rates, depending on how much joint working is already happening. Large GP groups may see an opportunity to drive their businesses forward, if necessary reconfiguring themselves to align closely with the network boundaries, so that PCNs become vehicles for further growth and development.
Threats to existing large groups may also arise, particularly those whose member practices are widely dispersed across several networks. Unless their membership offer is strong, practices may see a better future by aligning locally, within their PCN, rather than try to work with the complexity of belonging to two different groupings.
The general practice landscape is uncertain at present, but it may become very much clearer in the coming months. The Partnership Review will report, the NHS England guidance on PCNs will be published, and the NHS England Long Term Plan, the GMS Contract negotiations and the GP Premises review will reach their conclusions.
In the new year, wise GPs will be considering their options and determining the best course of action for them, for their practices, and for their patients. What is clear is that, like all providers of NHS services, they will be working as part of an increasingly integrated local health and care system with a defined population.
Within these structures, individual practices will find they have more and more in common with their neighbours, as commissioners implement a single approach across networks, with minimal or no tolerance for variation at individual practice level.
It will be for GPs and practice managers to determine how practices remain viable, and sustainable, in this new NHS world. There are several strategic options, and the advent of PCNs will mean that no practice is working in complete isolation from their neighbours.
In 2019 we will see whether the existing federations and super-partnerships, which are still young organisations, will prove to have been a blind alley, or the beginning of a much wider trend towards integrating general practice with both itself, and with other NHS providers.